Clinical Study of Gout

Sohn, Sung Keun; Kim, Seong Soo; Lee, Jung Yoon; Kim, Hyung Jin; Kim, Chul Hong

Abstract

Primary gout is a metabolic disease that has its basis in an inborn error in the intermediary metabolism of purines and related compounds. It is characterized by hyperuricemia, recurrent attacks of acute arthritis, deposition of monosodium urate crystals in and around the joints of the extremities, urolithiasis, renal and cardiovascular disease. Thirty-eight patients with gout managed at the department of orthopaedic surgery, Dong-A University Hospital, from April, 1990 to November 1993, had been reviewed retrospectively and the following results were obtained. 1. Most of cases were male(95%) and the mean age was 55.4 years old. 2. The case of first attack was 8 cases(21%), the most common age of first attack was fifth decade and mean duration of disease was 7.4 years. 3. The most common precipitating factor was overindulgence in food and alcohol. 4. The avarage uric acid level of serum and that 24-hour urine collection in acute attacks were 11.2 mg/dl and 24.5mg/D. Respectively all of the cases except four revealed increased ESR (average 43 mm/hr). 5. When the acute attack was developed, the most common involved joint was the first M-P joint (83%) of the foot, but as the acute gout was progressed to the chronic form, multiple joints were affected. 6, The punched out lesion in the radiograph was found in 7 cases(25 joints), among them 6 cases had suffered from the disease for longer than 3 years. 7. The most common complication was nephropathy(18 cases). 8. In case of acute gouty attack, we administered colchicine in the 22 cases. The therapeutic method of colchicine usually consisted of oral administration of 2 tablets(1.3mg) initially, followed by 1 tablet(0.65mg) every hour untill the relief of joint pain or the development of gastointestinal symptoms. We rocomended 6-8 tablets of colchicine for the management of acute gouty attack with safety. 9. Colchicine in small daily dose(0.65mg qd or bid) could be effective to prevent the recurrent attacks of high risk gouty arthritis.